HomeMy WebLinkAbout038-1119-70-100
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r~ ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
r r r u r u r x■ „r,6 ST. CROIX COUNTY GOVERNMENT CENTER
SAN , 1101 Carmichael Road
- - , - - Hudson, WI 54016-7710
(715) 386-4680
June 19, 1995
Mr. Kyle Magnus
P.o. Box 192
Somerset, Wisconsin 54025
RE: Water Results for Residence Located at
925 192nd Avenue, Somerset, Wisconsin
Dear Mr. Magnus:
Enclosed is the original test results from Commercial Testing
Laboratory, Inc. for water inspection of the above property. If
you have any questions with regard to said report, please let me
know.
Sincer ly,
mes K. T ompso
Assistant Zoning Administrator
St. Croix County, Wisconsin
mz
Enclosure
,rt COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
FAX - 715 - 962 - 4030
1
ST. CROIX COUNTY ZONING OFFICE REPORT NO.. 85725/01 PAGE
ST.CROIX CTY GOV.CTR REPORT DATE. 6/12/95
1101 CARMICHAEI. ROAD ;SATE RECEIVED. 6/06/95
HUDSON, WI 54016
ATTN. THOMAS C. NELSON
OWNER; Mike h Joan rutliff
LOCATION. 925 192nd Ave., Somerset
COLLECT,OR4* Jim Thompson y
DATE COLLECTED. 6-05-95
TIME COLLECTED: 1220pm
SOURCE OF SAMPLE: Kitchen tap
DATE ANALYZED.6-06-95''. tir
TIME ANALYZED.2;00pm ~cF =
COLIFORM,MFCC. 0 !100
INTERPRETATION. Bacteritlag ically SAFE
NITRATE--N. { O.Sppm
Above 10 ppm exceeds the re..ommended Public
Drinfsing Water Standard.
Cotiform Bacteria/100 ML
Nitrate-Nitrogen, mg/L
LAP TECHNICIAN. Pam Gane
WI Approved Lab No. 19
OF.\NDEPFIyOF,HT
2(y `'d )
J O
O D
Ia Means "LESS THAN" Detectable Level Approved by.,t.
PROFESSIONAL LABORATORY SERVICES SINCE 1952
~ 3-95
ST. CROIX COUNTY
b ~47
.
WISCONSIN
ZONING OFFICE
r r u p r move~ ST. CROIX COUNTY GOVERNMENT CENTER
r;,, • 1101 Carmichael Road
- - - Hudson, WI 540 1 6-77 1 0
(715) 386-4680
SEPTIC INSPECTION / WATER TEST REQUEST FORM
Please specify desired test(s) & remit appropriate fee with
application. Outside water lines are often turned off during
winter months, making access to the home necessary. Please make
arrangements with this office to insure that entry can be gained.
0 Water (VOC's) $185.00 ❑ septic $50.00
`1, Water (Nitrate & Bacteria) 45.00 0 Nitrate & Bacteria
retest $15.00
Owner: Requested by : ~`c ~~(J
Address: ~ 5- /q i ¢ve Address:
exf
Sashr~'~PS~~ ZIP$-(/ozS SeF LJ1, ZIP<~,oS-
Telephone W: (7i5) ~?c17 6-f~_2L_ Telephone N4: (71~--) __7y7 -•~7o~
Property address (Fire NQ & Street) :
Location:Sec., T_N, RW, Town of
Realty firm: Lock Box Combo: Closing Date: -
0 - 0 M61 C,
TO BE COMPLETED BY PROPERTY OWNER
*PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM*
Water sample tap location:
Is the dwelling currently occupied? Yes ❑ No
If vacant, date last occupied:
Age of septic system:
Septic tank last pumped by: Date:
Previous Owner's Name(s):
Have any of the following been observed?
OY ❑N Slow drainage from house.
❑Y ❑N Sewage Back-up into dwelling.
❑Y ❑N Sewage discharge to ground surface or road ditch.
❑Y ❑N Foul odors.
Other comments relative tsystem operation:
I certify that the above information is complete and true to the
best of my knowledge.
OWNERS SIGNATURE: DATE:6~S
1/94 a~
i
OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION
IN
TO BE COMPLETED BY INSPECTION AGENCY
System design &/or permit on file? []Yes ONo
Soil series per SCS Soil Survey: sheet #
Type of soil absorption system: OBelow grd []At-Grd []Mound
Approx. size 'X []Gravity []Dose []Pressurized
Ft.2 []Bed []Trench []Dry Well
[]Holding Tank OOutfall pipe
OBSERVED DEFICIENCIES []Other []Unknown
Septic tank
Setbacks: []House []Well []Prop. line OOther
Dose tank
Setbacks: []House []Well []Prop. line []Other
[]Locking cover OWarning label []Pump/Floats
[]Alarm []Elec. wiring
Soil Absorption System
Setbacks: []House 0Well []Prop. line OOther
OPonding: []Discharge:
General comments:
INSPECTORS SKETCH OF SYSTEM LOCATION
N
Inspector
Title
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER q ~L ItiQ
ADDRESS S Aga p,
SUBDIVISION / CSM# LOT #
SECTION 9 T_3j_N-R_L~__W, Town of 5~2r
ST. CROIX COUNTY, WISCONSIN
~e
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SY T M /
a
2 SQ
y s.-
s
. cve~
Wa-~- 34
f
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: ~
ALTERNATE BM:
PTIC T / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: A) .0 kjA -D
Liquid Capacity: (3(
Setback from: Well 3 ~J House 5 other
Pump: Manufacturer Model# r Size l
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
r
Width:-/2 Length 44 Number of trenches
Distance & Direction to nearest prop, line: --2
Jd r~
Setback from: well: 6 Houses Other
q Z ELEVATIONS
Building Sewer ST Inlet: mil' 3 ~ ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grades. Final grade
DATE OF INSTALLATION: 2
PLUMBER ON JOB: yyu.~ ~ Jr
LICENSE NUMBER: 3=r,
INSPECTOR:
3 / 9 3 : j t
iWisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 299023
Permit Holder's Name: ❑ City ❑ Villag Town of: State Plan ID No.:
GNUS, KYLE STAR PRAIRIE
T BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.:
l /L /GG . Ct , 038-1119-70-100
01
TANK INFORMATION ELEVATION DATA A9700340 90 57111F7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 0.6,~ /l/J, 66'
Dosi ng
Aeration Bldg. Sewer 7 -23A
Holder St/ Inlet
TANK SETBACK INFORMATION St/Xoutlet ~
Ventto
TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet
Septic NA Dt Bottom
Dosing NA Headers q '
Aeration A Dist. Pipe
Holding Bot. System d 4~ d, ~0
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand S
odel Number GPM
TDH Friction Vs t
H
Loss ead
Ofcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches No. Of Pits Inside Dia. Liquid Depth
PIT-
DIMENSIONS l S IMEN I N
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING urer:
SETBACK
INFORMATION Type Of CHAM Mode Number:
System: OR IT
DISTRIBUTION SYSTEM
Header/PAW*FWW ri Distribution Pipe(s) x Hole size x Hole 5 nt To Air Intake
Length Dia- Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At- de Systems
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx
Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: STAR PRARIE 29.31. 18. 494C, SE, SW 925 192ND AVE /~~n/,.✓
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. I FF1 ij
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH r
SANITARY PERMIT NUMBER:
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 E. Washington Ave.
Visconsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Department of Commerce Madison, WI W707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County `
than 8 1/2 x 11 inches in size. c
• See reverse side for instructions for completing this application State Sanitar Pe it umber
A11Da.-
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N
Property Owner Name Property Location
t/a 1/4,S T , N, R/ ( W
Property Owner's Mailin ddress Lot Number Block Number
City, S a t Zip Code hone Number Subdivision Name or CSM Number
1 . TYPE B IL13ING: (check one) State Owned City Nearest Road /
Public 1 or 2 Family Dwelling - No. of bedrooms oan of ,S~ar~~r~.~.=
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax cNumber(s)
1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable)
A) 1. ❑ New da"Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
______System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11>4eepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Minn/inch) Elevation
Feet
6 cic :3 646 17 !j'~ Feet
l 4--
VII. TANK Ca
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' ame: (Print) c Plumber's ure: (No tam S) MP/MPRSW No.: Business Phone Number:
1 / ?6l
Plum Piress (Street, City, State, Zip Code):
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing ent Signatu a (No fSta)
Surcharge Fee) tO ~7
pproved ❑ Owner Given Initial
/L 91e lz-va.4~
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
38D-(IM (Rt tom) DISTRIBUTION: Original to County, One copy To: Safety a Buildings Division, Owner, rn.mser
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed p6mper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3151.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County / Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
PLOT PLAN
PROJECT Kvle Maanus ADDRESS 925 192nd Ave New Richmond Wi 54017
SE 1/4 SW 1/4S 29 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
9/3/97 BEDROOM 3
MPRS BYRON BIRD JR. 3318 DATE
CONVENTIONAL XXX IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 BED SIZE 12' X 54' Bed
BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL -H.R.P, Same as Benchmark
VENT SYSTEM ELEVATION 92.3
12" GRADE
TYPAR COVERING
12" 3' 6' Q 3' 0% Slope
SEWER R K '
12' Vent B-3
I
I 30'
12' X 54' Bed
I -2
a.
Y
I 30'
>250' to
Property
30' Line
0'
10' 55' B-1
Shed 12'
16' 20' P~~ao
B.M. 5
T 60
40'
36' T 'F~ To tt a b~ w,~ d
Driveway edroo xdroom 3 House as wcede.
rt
e
32' Well
Wsconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County -
include, but not limited to: vertical and horizontal reference point (BM), direction and D4, C r-0 171,
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
C'_" -1 7
APPLICANT INFORMATION - Please print all information. Reviewed by Data
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Q Govt. Lot S t^ 1/4 /4,S a T N,R E (or
K 1 1►
CA rulA
Property Owner's Mailin Address Lot # Block# Subd. Name or CSM#
'r-
C're, I
ity State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
1 5yo1 0 15 f I°l
El New Construction Use: AX-
'2!rBesidenlial / Number of bedrooms > Addition to existing building
JR Replacement ❑ Public or commercial - Describe: d
Code derived dail flow ~ O
Pd Recommended design loading rate bed, 9P~ . 9P~
9
Y
Absorption area requirebed, ft2_j~3 trench, tt2 M 'mum design loading rate L 7 bed, gpde , Y trench, gpde
Recommended infiltration surface elevation(s) 9~' ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material oweto Flood plain elevation, if applicable N ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade
T System in III Holding Tank
U = Unsuitable for system S ❑ U XS ❑ U S ❑ U 9S ❑ U ❑ S Ef, u ❑ S r°~-u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/1`12
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
0-13
r v? 2~ ►M- S ' b
Ground 3 6' / S omS lid
e v. ;
ft.
Depth to
limiting
_tactor
3 Remarks:
Boring # _ ,r C2~
C9
Ground
,,,ele
~V
~epth to
limiting
.;~in. Remarks:
CST Name (Please Print) Signature Telephone No.
Address Date CST Number
6 - ~ ~ 5q0o g-a S- 7 ~ 3
SOIL DESCRIPTION REPORT
PROPERTY OWNER Q Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground
elev.
Depth to
limiting
fa o
17in.
Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
tt.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft. ,
Depth to
limiting
factor
in. Remarks:
SBD-8330 (R. 07/96)
Soil Test Plot Plan
Project Name Kyle Magnus Byron Bird Jr.
Address 925 192nd Ave
New Richmond Wi 54017 CSTM #3479
Lot Subdivision Date 8/24/97
SE 1/4SW 1/4S29 T 31 N/R 18 W Township Star Prairie
Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Base of Siding
System Elevation 92.3 * H R P Same as Benchmark
0% Slope
B-3 '
0'
~o
N
-2
a
C
N
30'>250' to
[Property
30' e
hwm~
0'
B-1
F12'
Shed 16'
20'
*B.M. L36'
y Existing 3 Drivewa HoPinedroom ' to
erty
ll e
440599
CERTIFIED SURVEY MAP
Located in part of the SE4 of the SWh of Section 29, T31N, R18W,
Town of Star Prairie, St. Croix County, Wisconsin.
8 9
~ AUGI E~ ~
"a 81988
Pwmu
Unplatt_ed Lands home
North line of the SE} of the SWJ of Section 29 M Oak Ca
192ND AVENUE 8
s N89016127"E 750.00'
6, 89°19'02"E 150.00'
Town Road R/W
L Oa
N N HOUSE=
w
O C N L0 Lr)
0 40
_N I
4J O
0 N d BARN
L. 4- Go y SHED
0 O
w o x O 11 1~
4,.-w L o • SHED p
r- 3C w
0 00
vi
4) y .G N I s °p C 1
_a 1 Ln' A S O .j
41 4j i
Ol C&. -0 W dl
C O, ~I~ LOT 1=
L d N m 1 O- t0
co o i.,. LO Area Including R/W: LO a {
434,999 Sq. Ft. rn 1
1 d 9.99 Acres o 'Cr
0 0 Area Excluding R/W: o
z 423,531 Sq. Ft.
9.72 Acres
4J
N
3
4 SS89016127"W 750.00'
a
_ Unplatted Lands
SCALE IN FEET
O M
Co C1 0 100 200 300
SW Corner of Sj Corner of
Section 29 Section 29
1313.66' 1313.66'
N89°2:9'26"E
South line of the SWJ of Section 29 - N8902912611E, 2627.32'
LEGEND
County Section Monument OWNER
L 'i C: L o u
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/ contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
owner of property
Location of propert 1/4_SLz/1/4 , Section o<1 T~N-R W
Townships mailing address
Address of site
Subdivision name Lot no.
other homes on property? Yes No
Previous owner of property zE'
Total size of property ~ f ZZ
Total size of parcel
Date parcel was created 7
Are all corners and lot lc?nes identifiable? Yes No
Is this property being developed for (spec house)? Yes e-'- No
Volumezl~ and Page Number J~8 S as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
prcperty described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signatu e Applicant Co-Applicant
Da o Signature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
/ St. Croix County
OWNER/BUYER It
MAILING ADDRESS
PROPERTY ADDRESS
(location of septic system) Please obt/ain~ from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 1/4, 1/4, Section T,-z:?/ N-R_a_W
TOWN OF SQ✓ /-ice ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMMBER_
,
CERTIFIED SURVEY MAPy _ OLUME AGE LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60%. of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expi tion t .
SIGNED:
DATE:
7
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, Wt 54016 11/93
s
_ >H NS So S o a Y6 i~
i State Bar of Wisconsin Form 2 - 1982
WARRANTY DEED
DOCUMENT NO. I 127-P-A r
('T C C 1,
t;ih d fix F
__-lic1me-1 E. Sutai.f.L and- JQattStttliff_a!_kLa-----
Joan F-Sutliff. usband. x wife} JUN 98 199
- 4t 10:45 A. ej
conveys and warrants to Kyle H. Magnus. aka t
Kyle Hamlin Magnus, a single person(: tawcl• G.+-~.
r7~ THIS SPACE RESERVED FOR RECORDING DATA i
g
- .7 YrtiE AND RETURN ADDRESS
the following described real estate in - St. Croix
County, State of Wisconsin:
;lance Identification Number)
i Part of the SE1/4 of the SWl14 of Section 29, Township 31 North, Range 18 West, it
uwn of Star Prairie, St. Croix County, Wisconsin, described as follows: q
Lot 1 of Certified Survey Map recorded August 18, 1988, in Volume 7, of
Certified Survey Maps, page 2011, as Doc. No. 440599.
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This is homestead property.
Exception to warranties: Easements, restrictions and rigb ts-of-way of record, if any.
r
~i
Dated this day of June I9 95
i
(SEAL) (SEAL`
(SEAL) _ (SEAL)
• Joan Sutlif f . a/k/a Joan F. Sutlif f
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Michael E. Sutliff, Joan Sutliff, STATE OF WISCONSIN
/A .;oan F. Sutliff
Q L County.
authenticated this - day of June 1995 111bri c ly ame before me this day of
- 19 the above named t
• Kristi Ogland
TITLE: MEMB tit STATE BAR OF WISCONSIN
(If not.
authorized by §706.06, Wis. Stats-) to use =no-we ao be the person _ who executed the
rego mrmuesent and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY fo